[28F] With shoulder pain and associated symptoms

Patient Description

A 28-year-old female has been experiencing pain between her left shoulder blade and spine for several weeks. The pain is described as burning and sharp, tender to the touch, and sometimes accompanied by tingling or numbness. The pain worsens with reaching above her head and leaning her head to the right. She has not had any prior injuries to her shoulder or arm. In addition to the shoulder pain, she reports fatigue. The pain occurs a few times daily, lasting from 10 minutes to a few hours. Heat application and taking 2 Aleve provide some relief. She has noticed a decrease in strength in her shoulder and arm but no visible swelling or changes in appearance. She also experiences neck pain and occasional complete numbness in her arm. She has a history of migraines, diagnosed at age 23, and PTSD, diagnosed at age 11. She does not smoke, drinks wine occasionally, and maintains a diet with adequate nutrients, including calcium and vitamin D. She has not traveled recently. She is currently taking Qulipta 60 mg, Abilify 5 mg, and Lexapro 10 mg, all once daily, and has been on these medications for about a year and a half. She has no known drug allergies but has a reaction to certain steroids that cause her blood pressure to drop.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Cervical Radiculopathy (Pinched Nerve): This condition occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. This can cause sharp, burning pain that radiates to the shoulder blade and arm, along with tingling, numbness, and muscle weakness.

    • Typical Treatments: Physical therapy, medications like NSAIDs (e.g., Aleve), corticosteroid injections, and in severe cases, surgery. Diagnostic tests may include MRI or CT scans to visualize the affected nerves.
  • Rotator Cuff Tendinitis or Tear: Inflammation or tearing of the rotator cuff tendons can cause shoulder pain, especially when reaching overhead. This condition can also lead to weakness and tenderness.

    • Typical Treatments: Rest, ice, physical therapy, anti-inflammatory medications, and sometimes corticosteroid injections. An MRI may be used to confirm the diagnosis.
  • Myofascial Pain Syndrome: This is a chronic pain disorder where pressure on sensitive points in your muscles (trigger points) causes pain in seemingly unrelated parts of your body. This could explain the tenderness and radiating pain.

    • Typical Treatments: Physical therapy, trigger point injections, medications, and stress management techniques.
  • Migraine-Related Neck Pain: Since you have a history of migraines, it's possible that your neck pain and shoulder discomfort are related to your migraines. Migraines can sometimes cause referred pain to the neck and shoulders.

    • Typical Treatments: Migraine management through medications, lifestyle changes, and avoiding known triggers.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take to manage your symptoms:

  1. Continue Using Heat: Applying heat to the affected area can help relax the muscles and reduce pain.
  2. Over-the-Counter Pain Relief: Continue taking Aleve (naproxen) as it seems to help. Always follow the dosage instructions on the label.
  3. Gentle Stretching and Strengthening Exercises: Engage in gentle neck and shoulder stretches to improve flexibility and reduce muscle tension. Physical therapy exercises can be particularly beneficial.
  4. Posture Improvement: Pay attention to your posture, especially if you spend a lot of time sitting or working at a computer. Ergonomic adjustments can help reduce strain on your neck and shoulders.
  5. Symptom Tracking: Use MDandMe to journal your symptoms, track your progress, and get insights. This can be helpful information to share with your healthcare provider.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe or Worsening Pain: If your pain becomes unbearable or significantly worsens.
  • Loss of Function: If you experience significant weakness or loss of function in your arm or hand.
  • New or Worsening Symptoms: If you develop new symptoms such as severe headaches, dizziness, or balance issues.
  • Signs of Infection: If you notice redness, swelling, or warmth in the affected area, which could indicate an infection.

Remember, while this information can be helpful, it is not a substitute for professional medical advice. Please consult a healthcare provider for a formal diagnosis and appropriate treatment.

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5 mo ago

People Also Ask


What is cervical radiculopathy and how is it treated?

Cervical radiculopathy, also known as a pinched nerve, occurs when a nerve in the neck is compressed or irritated. This can cause sharp, burning pain that radiates to the shoulder blade and arm, along with tingling, numbness, and muscle weakness. Treatment options include physical therapy, NSAIDs, corticosteroid injections, and in severe cases, surgery. Diagnostic tests like MRI or CT scans may be used to visualize the affected nerves.


How can rotator cuff tendinitis or tear be diagnosed and managed?

Rotator cuff tendinitis or tear involves inflammation or tearing of the rotator cuff tendons, causing shoulder pain, especially when reaching overhead. Diagnosis may involve physical examination and imaging tests like MRI. Management includes rest, ice, physical therapy, anti-inflammatory medications, and sometimes corticosteroid injections.


What is myofascial pain syndrome and what are its treatment options?

Myofascial pain syndrome is a chronic pain disorder where pressure on sensitive points in muscles (trigger points) causes pain in unrelated parts of the body. Treatment options include physical therapy, trigger point injections, medications, and stress management techniques.


Can migraines cause neck and shoulder pain, and how can this be managed?

Migraines can sometimes cause referred pain to the neck and shoulders, known as migraine-related neck pain. Management involves migraine-specific treatments, lifestyle changes, and avoiding known triggers. Medications and physical therapy may also help alleviate associated neck and shoulder pain.


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1 Comments


Angelina#43016

4 mo ago

I'm no medical expert nor have I stufied.medicine however I've my share of issues...what can I say I'm blessed. Nor am I disagree with Arora . Just something to consider.. you may have inflammation constricting a area of small blood vessels that may cause blood circulating properly.. this can be easily overlooked . This can cause a variety of issues included numbness. Just sharing my personal experience with hopes it is of some use. Thank you for sharing

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